Chapter 39- Assessment of Musculoskeletal Function Prepu
The nurse is conducting the admission assessment for a client who is to undergo an arthrogram. What is the priority question the nurse should ask?
"Do you have any allergies?" "When did you last eat?" "When did you last urinate?" "Are you claustrophobic?"
A client undergoes an arthroscopy at the outpatient clinic. After the procedure, the nurse provides discharge teaching. Which response by the client indicates the need for further teaching?
"Elevating my leg will reduce swelling after the procedure." "My physician may prescribe pain pills after the procedure." "I should use my heating pad this evening to reduce some of the pain in my knee." "I may notice some bruising or swelling in my knee."
The nurse is preparing the client for magnetic resonance imaging after reports of low back pain. What statement by the client requires action by the nurse?
"I didn't remove my Transderm-Nitro patch." "I do not have any artificial joints." "I removed my hearing aids." "I do not have a pacemaker."
A client with a sports injury undergoes a diagnostic arthroscopy of the left knee. What comment by the client following the procedure will the nurse address first?
"My toes are numb." "My knee aches." "My feet are cold." "My foot is swollen."
The older client asks the nurse how best to maintain strong muscles. What is the nurse's best response?
"Weight-resistance exercises can strengthen muscles." "Cardio-training is the best way to build muscle." "Getting a lot of rest can strengthen muscles." "Range of motion exercises build muscle mass."
The nurse is assessing a new client with a musculoskeletal problem. What is the best question by the nurse to elicit more information related to the injury?
"What is your age?" "What kind of work do you do?" "Do you have any chronic disorder or recent injury?" What is the duration and location of discomfort or pain?"
The nurse is preparing the client with a right neck mass for magnetic resonance imaging (MRI). Which question should the nurse ask? Select all that apply.
"When is the last time you had food or drink?" "Are you wearing any jewelry?" "Have you removed your hearing aid?" "Do you have a pacemaker?" "Did you take your medications this morning?"
A patient tells the nurse, "I was working out and lifting weights and now that I have stopped, I am flabby and my muscles have gone!" What is the best response by the nurse?
"While you are lifting weights, endorphins are released, creating increase in muscle mass, but if the muscles are not used they will atrophy." "The muscle mass has decreased from the lack of calcium in the cells." "Your muscles were in a state of hypertrophy from the weight lifting but it will persist only if the exercise is continued." "Once you stop exercising, the contraction of the muscle does not regain its strength."
Patient education for musculoskeletal conditions for the aging is based on the understanding that there is a gradual loss of bone after a peak of bone mass at age:
20 years. 30 years. 40 years. 50 years.
A client arrives at the orthopedic physician's office stating knee pain sustained while playing soccer. A history and physical assessment is completed. The knee appears reddened with edema. Which other diagnostic testing would the nurse anticipate?
A bone densitometry A bone scan An arthrocentesis An arthroscopy
A nurse is caring for a client whose cancer metastasis has resulted in bone pain. What should the nurse expect the client to describe?
A dull, deep ache that is "boring" in nature Soreness or aching that may include cramping Sharp, piercing pain that is relieved by immobilization Spastic or sharp pain that radiates
Which term refers to moving away from midline?
Adduction Inversion Eversion Abduction
The primary functions of cartilage are to reduce friction between articular surfaces, absorb shocks, and reduce stress on joint surfaces. Where in the human body is cartilage found?
All options are correct. between the ribs covering elbow joints between the vertebrae
Which elements of assessment of a traumatic musculoskeletal injury should be included when a client is evaluated. Select all that apply.
All should be included. Observe for swelling, external bleeding, or bruising. Palpate the peripheral pulses. Check the sensation of the injured part.
What is the term for a rhythmic contraction of a muscle?
Atrophy Clonus Hypertrophy Crepitus
A group of students are studying for an examination on joints. The students demonstrate understanding of the material when they identify which of the following as an example of a synarthrodial joint?
Between the vertebrae In the fingers At the hip Skull at the temporal and occipital bones
A nurse is caring for a client with a diagnosis of cancer that has metastasized. What laboratory value would the nurse expect to be elevated in this client?
Bilirubin Potassium Alkaline phosphatase Creatinine
An older adult client has symptoms of osteoporosis and is being assessed during her annual physical examination. The assessment shows that the client will require further testing related to a possible exacerbation of her osteoporosis. The nurse should anticipate what diagnostic test?
Bone densitometry Hip bone radiography Computed tomography (CT) Magnetic resonance imaging (MRI)
Which description refers to an osteon?
Bone-forming cell Microscopic functional bone unit Bone resorption cell Mature bone cell
Which term refers to a grating or crackling sound or sensation?
Callus Clonus Fasciculation Crepitus
Which cells are involved in bone resorption?
Chondrocytes Osteoblasts Osteoclasts Osteocytes
A client is diagnosed with a bone tumor. What result would the nurse expect the blood tests to reveal?
Decreased alkaline phosphatase Decreased serum calcium level Decreased serum phosphorus Decreased red blood cell count
Which diagnostic test would the nurse expect to be ordered for a client with lower extremity muscle weakness?
Electromyograph (EMG) Arthrocentesis Bone scan Biopsy
Which term refers to mature compact bone structures that form concentric rings of bone matrix?
Endosteum Lamellae Trabecula Cancellous bone
Which term refers to the shaft of the long bone?
Epiphysis Lordosis Scoliosis Diaphysis
Which of the following is the most common site of joint effusion?
Knee Elbow Hip Shoulder
Which is useful in identifying acute or chronic tears of the joint capsule or supporting ligaments of the knee, shoulder, ankle, hip, or wrist?
Meniscography Bone densitometry Arthrography EMG
The nurse is performing an assessment for a patient who may have peripheral neurovascular dysfunction. What signs does the patient present with that indicate circulation is impaired? (Select all that apply.)
Pale, cyanotic, or mottled color Cool temperature of the extremity More than 3-second capillary refill Tenting skin turgor Limited range of motion
Which nerve is being assessed when the nurses asks the client to dorsiflex the ankle and extend the toes?
Radial Peroneal Median Ulnar
Which of the following is the final stage of fracture repair?
Remodeling Cartilage calcification Cartilage removal Angiogenesis
A patient has had a stroke and is unable to move the right upper and lower extremity. During assessment the nurse picks up the arm and it is limp and without tone. How would the nurse document this finding?
Rigidity Flaccidity Atonic Tetanic
Which of the following is an appropriate priority nursing diagnosis for the client following an arthrocentesis?
Risk for infection Chronic pain Deficient knowledge: procedure Activity intolerance
Skull sutures are an example of which type of joint?
Synarthrosis Amphiarthrosis Diarthrosis Aponeuroses
Which laboratory study indicates the rate of bone turnover?
Urine calcium Serum calcium Serum phosphorous Serum osteocalcin
The nurse is teaching a client about a vitamin that supports calcium's absorption. What vitamin is the nurse teaching the client about?
Vitamin A Vitamin B12 Vitamin C Vitamin D
The nurse is evaluating a client's peripheral neurovascular status. Which would the nurse report to the health care provider as a circulatory indicator of peripheral neurovascular dysfunction?
Weakness Paresthesia Cool skin Paralysis
A client has just had an arthroscopy performed to assess a knee injury. What nursing intervention should the nurse perform following this procedure?
Wrap the joint in a compression dressing. Perform passive range of motion exercises. Maintain the knee in flexion for up to 30 minutes. Apply heat to the knee.
An example of a flat bone is the
femur. sternum. vertebra. metacarpals.
Identify the area on the figure where the nurse would assess for lordosis.
x
Diagnostic tests show that a client's bone density has decreased over the past several years. The client asks the nurse what factors contribute to bone density decreasing. What would be the nurse's best response?
"For many people, lack of nutrition can cause a loss of bone density." "Progressive loss of bone density is mostly related to your genes." "Stress is known to have many unhealthy effects, including reduced bone density." "Bone density decreases with age, but scientists are not exactly sure why this is the case."
Which statement by the client preparing for a bone scan indicates further teaching by the nurse is needed?
"I will need to limit my fluid intake so as not to interfere with the isotope." "The scan is done a couple of hours after the isotope is injected." "The radioisotope will be injected through my IV." "I will need to empty my bladder before I go for the scan."
A nursing student asks the nurse why older adults are at risk for falls. The best response by the nurse is:
"Muscles atrophy with aging." "Bones become more fragile." "Cartilage deteriorates with age." "Ligaments become lax with age."
What instructions should the nurse include in the discharge teaching for the client following an arthroscopy?
"The pain should be well-controlled with Tylenol." "Numbness and tingling in the foot are expected the first 24 hours." "It is normal to feel hot spots over the puncture site." "Keep the leg in the dependent position as much as possible."
A nurse is caring for a client who has been scheduled for a bone scan. What should the nurse teach the client about this diagnostic test?
"The test is brief and requires that you drink a calcium solution 2 hours before the test." "You will not be allowed fluid for 2 hours before and 3 hours after the test." "You'll be encouraged to drink water after the administration of the radioisotope injection." "This is a common test that can be safely performed on anyone."
The nurse is preparing the client for computed tomography. Which information should be given by the nurse?
"You must remain very still during the procedure." "A small bit of tissue will be removed and sent to the lab." "Fluid will be removed from you affected joint." "A radioisotope will be given through an IV."
A client is experiencing muscle weakness in the upper extremities. The client raises an arm above the head but then loses the ability to maintain the position. Muscular dystrophy is suspected. Which diagnostic test would evaluate muscle weakness or deterioration?
A serum calcium test An electromyography An arthroscopy A magnetic resonance imaging (MRI)
Which assessment findings indicate to the nurse that a client may have peripheral neurovascular dysfunction? Select all that apply.
Absence of feeling Capillary refill of 4 to 5 seconds Cool skin Pain Redness of the skin Weakness in motion
Which statement describes paresthesia?
Absence of muscle movement suggesting nerve damage Involuntary twitch of muscle fibers Abnormal sensations Absence of muscle tone
Which statement reflects the progress of bone healing?
All fracture healing takes place at the same rate no matter the type of bone fractured. Serial x-rays are used to monitor the progress of bone healing. The age of the client influences the rate of fracture healing. Adequate immobilization is essential until ultrasound shows evidence of bone formation with ossification.
A client is undergoing diagnostic testing for suspected Paget disease. What assessment finding is most consistent with this diagnosis?
Altered serum magnesium levels Altered serum calcium levels Altered serum potassium levels Altered serum sodium levels
A patient is undergoing diagnostic testing for suspected Paget's disease. What assessment finding is most consistent with this diagnosis?
Altered serum magnesium levels Altered serum calcium levels Altered serum potassium levels Altered serum sodium levels
A client is recovering from a fractured hip. The nurse would suggest that the client increase intake of which of the following to facilitate calcium absorption from food and supplements?
Amino acids Vitamin B6 Vitamin D Dairy products
A client is recovering from a fractured hip. What would the nurse suggest that the client increase intake of to facilitate calcium absorption from food and supplements?
Amino acids Vitamin B6 Vitamin D Dairy products
A client is having repeated tears of the joint capsule in the shoulder, and the health care provider orders an arthrogram. What intervention should the nurse provide after the procedure is completed? Select all that apply.
Apply a compression bandage to the area. Apply heat to the area for 48 hours. Administer a mild analgesic. Inform the client that a clicking or crackling noise in the joint may persist for a couple of days. Actively exercise the area immediately after the procedure.
A client comes to the emergency department with reports of pain in the left ankle. The client states, "I missed a step coming down the stairs, and landed funny." The ankle is swollen and tender to the touch. What will the nurse do to help control the swelling?
Apply heat to the ankle. Tell the client to flex the left foot frequently. Have the client dangle the left leg over the side of the bed. Raise the left leg above the level of the heart.
Which of the following diagnostic studies are done to relieve joint pain due to effusion?
Arthrocentesis Electromyography (EMG) Bone scan Biopsy
The nurse is performing a neurological assessment. What will this assessment include?
Ask the client to plantar flex the toes. Observe for capillary refill of the great toe. Palpate the dorsalis pedis pulse. Inspect the foot for edema.
A nurse is caring for a client who has an MRI scheduled. What is the priority safety action prior to this diagnostic procedure?
Assessing the client for signs and symptoms of active infection Ensuring that the client can remain immobile for up to 3 hours Assessing the client for a history of nut allergies Ensuring that there are no metal objects on or in the client
A client has just undergone arthrography. What is the most important instruction for the nurse to include in the teaching plan?
Avoid sunlight or harsh, dry climate. Avoid intake of dairy products. Report joint crackling or clicking noises occurring after the second day. Gently massage joints with any crackling or clicking joint noises.
A nurse provides health information to a postmenopausal woman who has been diagnosed with osteopenia. What mineral would the nurse recommend for this client?
Calcium Phosphorus Magnesium Fluoride
The nurse is assessing a client for dietary factors that may influence her risk for osteoporosis. The nurse should question the client about her intake of what nutrients? Select all that apply.
Calcium Simple carbohydrates Vitamin D Protein Soluble fiber
A nurse provides nutritional health teaching to an adult client who had two fractures in 1 year. Besides recommending supplemental calcium, the nurse suggests a high-calcium diet. What would the nurse recommend that the client increase intake of?
Canned mixed fruit. Salmon and sardines. Yogurt and cheese. Almonds and peanuts.
Which of the following is an example of a gliding joint?
Carpal bones in the wrist Knee Hip Joint at base of thumb
A client visits the health care provider for a routine checkup. The history reveals that the client was diagnosed with a spinal curvature. Which region of the spine should the nurse assess for complications?
Cervical Thoracic Lumbar Sacral
Which of the following factors would the nurse need to keep in mind about the focus of the initial history when assessing a new client with a musculoskeletal problem?
Client's age Client's lifestyle Any chronic disorder or recent injury Duration and location of discomfort or pain
The nurse is employed at a long-term care facility caring for geriatric clients. Which assessment finding is characteristic of an age-related change?
Cognitive decline Loss of height Depressive symptoms Increased muscle mass
The nurse is discussing an older adult's risk for skeletal fractures with a group of students assigned to the clinical area. Which of the following would the nurse most likely explain as the underlying reason for the increased risk?
Collagen formation decreases. Aging leads to a deficiency of calcium. No bone reformation occurs in the older adult. Bone resorption is more rapid than bone formation.
The nurse is caring for a client scheduled to have magnetic resonance imaging (MRI). The nurse contacts the health care provider to cancel the MRI when the nurse reads which element in the client's medical history?
Colostomy Cochlear implant Skin graft Tumor removal
The nurse is caring for a client who experienced a crushing injury of the lower extremities. Which of the following symptoms is essential to be reported to the physician?
Coolness Pain Pulselessness Ischemia
Which of the following biologically active vitamin functions to increase the amount of calcium in the blood?
D C E A
Which of the following is the priority nursing diagnosis for the client preparing for a bone marrow biopsy?
Deficient knowledge: procedure Acute pain Risk for infection Risk for ineffective peripheral tissue perfusion
A nurse is performing a musculoskeletal assessment of a client with arthritis. During passive range-of-motion exercises, the nurse hears an audible grating sound. The nurse should document the presence of what assessment finding?
Fasciculations Clonus Effusion Crepitus
A nurse is caring for a client who has just had an arthroscopy as an outpatient and is getting ready to go home. The nurse should teach the client to monitor closely for what postprocedure complication?
Fever Crepitus Fasciculations Synovial fluid leakage
The nurse is assessing the muscle tone of a client with cerebral palsy. Which description does the nurse determine to be an expected assessment of this client's muscle tone?
Flaccid Atonic Atrophied Hypertonic
Which of the following describes a muscle that is limp and without tone?
Flaccid Spastic Atonic Paralysis
Which hormone inhibits bone reabsorption and increases calcium deposit in the bone?
Growth hormone Vitamin D Sex hormones Calcitonin
Which hormone inhibits bone resorption and increases the deposit of calcium in the bone?
Growth hormone Vitamin D Sex hormones Calcitonin
A patient is scheduled for a bone marrow biopsy. The nurse explains to the family that the bone marrow is located mainly in four areas. She tells the family that the site to be used would be the:
Humerus. Sternum. Femur. Scapula.
A client is exhibiting diminished range of motion, loss of flexibility, stiffness, and loss of height. The history and physical findings are associated with age-related changes of which area?
Joints Bones Muscles Ligaments
The nurse is providing care to a client following a knee arthroscopy. What would the nurse expect to include in the client's plan of care?
Keeping the affected knee flexed. Applying warm packs to the insertion site. Maintaining the client's NPO status. Administering the prescribed analgesic.
Which of the following is an example of a hinge joint?
Knee Hip Joint at base of thumb Carpal bones in the wrist
Which of the following deformity causes a exaggerated curvature of the lumbar spine?
Lordosis Scoliosis Kyphosis Steppage gait
The nurse is performing an assessment on an older adult patient and observes the patient has an increased forward curvature of the thoracic spine. What does the nurse understand this common finding is known as?
Lordosis Scoliosis Osteoporosis Kyphosis
The nurse would expect which of the following age-related change of the musculoskeletal system?
Loss of bone mass Increased elasticity of tendons Thickening of intervertebral discs Muscle hypertrophy
A client is scheduled to undergo an electromyography. When performed, what will this test evaluate?
Muscle weakness Muscle composition Bone density Metastatic bone lesions
An osteocalcin (bone GLA protein) level has been ordered. How will the nurse prepare for this order?
Obtain a blood specimen. Obtain a clean-catch urine. Assist the health care provider in obtaining a synovial fluid specimen. Assist the health care provider in obtaining a bone marrow specimen.
A deoxypyridinoline (DPD) level has been ordered. How will the nurse prepare for this measurement?
Obtain a clean-catch urine. Obtain a blood specimen. Assist the health care provider in obtaining a synovial fluid specimen. Assist the health care provider in obtaining a bone marrow specimen.
A 10-year-old boy who was brought to the emergency room after a skiing accident is diagnosed with a fracture of the distal end of the femur. Why is this type of fracture significant?
Osteoblast formation will stop during the time needed for fracture healing. Red blood cell production will be temporarily reduced because of the damage to the medullar cavity. Potential growth problems may result from damage to the epiphyseal plate. Periosteal blood vessels will be damaged, thus compromising blood flow to the compact bone.
The nurse is caring for a client who has a deficiency in the formation of cartilage in joints. Which essential substance is absent?
Osteoblasts Sarcomeres Matrix Myofibrils
Which serum level indicates the rate of bone turnover?
Osteocalcin Myoglobin Creatinine kinase Aspartate aminotransferase
A public health nurse is organizing a campaign that will address the leading cause of musculoskeletal-related disability. The nurse should focus on what health problem?
Osteoporosis Arthritis Hip fractures Lower back pain
The results of a nurse's musculoskeletal examination show an increase in the lumbar curvature of the spine. The nurse should recognize the presence of what health problem?
Osteoporosis Kyphosis Lordosis Scoliosis
Which of the following are the major hormonal regulators of calcium homeostasis? Select all that apply.
Parathormone Calcitonin Thyroid Cortisol Growth hormone
The nurse observes a client with a shuffling gait. What disease is commonly associated with a shuffling gait?
Parkinson's disease lower motor neuron disease scoliosis Paget's disease
Red bone marrow produces which of the following? Select all that apply.
Platelets White blood cells (WBCs) Red blood cells (RBCs) Estrogen Corticosteroids
The nurse is caring for a pregnant patient with pregnancy-induced hypertension. When assessing the reflexes in the ankle, the nurse observes rhythmic contractions of the muscle when dorsiflexing the foot. What would the nurse document this finding as?
Positive Babinski reflex Clonus Hypertrophy Ankle reflex
The nurse is performing a neurovascular assessment of a client's injured extremity. Which would the nurse report?
Positive distal pulses Capillary refill of 3 seconds Dusky or mottled skin color Skin warm to touch
The nurse is assessing a client's peroneal nerve. What technique will the nurse use?
Prick the skin mid-way between the great and second toe. Ask the client to plantar flex the toes. Ask the client to invert and evert the foot. Prick the medial surface of the sole.
A nurse performs a neurovascular assessment on a client 2 weeks after a wrist cast had been removed. The nurse documents in the client's chart that there is normal sensation in the ulnar nerve. What finger assessment test will the nurse perform on this client?
Prick the skin midway between the thumb and second finger. Prick the distal fat pad on the small finger. Prick the top or distal surface of the index finger. Prick the top of the middle finger.
When assessing a client's peripheral nerve function, the nurse uses an instrument to prick the fat pad at the top of the client's small finger. This action will assess what nerve?
Radial Ulnar Median Tibial
A nurse is performing a nursing assessment of a client suspected of having a musculoskeletal disorder. What should the nurse prioritize during the assessment of a client who has a musculoskeletal disorder?
Range of motion Activities of daily living Gait Strength
A patient has a fracture of the right femur sustained in an automobile accident. What process of fracture healing does the nurse understand will occur with this patient?
Reactive phase, reparative phase, remodeling phase Primary phase, secondary phase, third phase First intention, secondary intention, third intention Active phase, dormant phase, restructure phase
The nurse is reporting on the results of client blood work to the oncoming nurse. Upon reviewing the data, it is noted that the client has an elevated uric acid level. Which inflammatory process would the nurse screen for on shift rounds?
Rheumatoid arthritis Lupus erythematosus Osteoporosis Gout
A group of students are reviewing the structure and function of bones. The students demonstrate understanding of the information when they state that cortical bone is found primarily in which of the following?
Rounded irregular ends Epiphyses Diaphyses Osteoblasts
The nurse is conducting a musculoskeletal assessment of a client in a nursing home. The client is unable to dorsiflex the right foot or extend the toes. The nurse evaluates this finding as an injury to which nerve?
Sciatic Peroneal Femoral Achilles
The nurse is conducting a musculoskeletal assessment on a client documented to have rheumatoid arthritis. Which would the nurse anticipate finding when inspecting the client's fingers?
Soft, subcutaneous nodules along the tendons Hard nodules adjacent to the joints Hard nodules of bony overgrowth Soft nodules along the palmar surface
A client is receiving ongoing nursing care for the treatment of Parkinson disease. When assessing this client's gait, what finding is most closely associated with this health problem?
Spastic hemiparesis gait Shuffling gait Rapid gait Steppage gait
A nurse provides health teaching to the family of an older adult client who has trouble walking independently. The nurse reviews age-related changes to the musculoskeletal system with the family. Which of the following statements would the nurse include in the teaching? Select all that apply.
Tendons become more elastic. Intervertebral discs become thin. Muscles atrophy. Muscle fibrosis increases. Collagen increases
A client has a fracture that is being treated with open rigid compression plate fixation devices. What teaching will the nurse reinforce to the client about how the progress of bone healing will be monitored?
The plate will be removed to determine if the bone is growing back. Serial x-rays will be taken. An arthroscopy will be performed. The bone will heal on its own without intervention.
A group of students are reviewing information about bones in preparation for a quiz. Which of the following indicates that the students have understood the material?
The yellow marrow is responsible for manufacturing red blood cells. Long bones typically contain more red bone marrow than yellow. Osteoclasts are involved in the destruction and remodeling of bone. Osteocytes are transformed into osteoblasts or mature bone cells.
The nurse understands that bone maintenance requires a balance between forming and dissolving bone. What is a correct statement about the function of osteoblasts?
They are multinuclear cells involved in resorbing bone. They secrete a matrix that consists of collagen. They are located in shallow lacunae (small pits in bones). They are nourished by capillaries that are part of the Haversian system.
A nurse is explaining a client's decreasing bone density in terms of the balance between bone resorption and formation. What dietary nutrients and hormones play a role in the resorption and formation of adult bones? Select all that apply.
Thyroid hormone Growth hormone Estrogen Vitamin B12 Luteinizing hormone
Which clinical manifestation would the nurse recognize as an indicator of peripheral neurovascular dysfunction? Select all that apply.
Toes mottled and cool Capillary refill less than 3 seconds Complaints of pins and needles in feet Absence of pain Dorsoplantar flexion strong
Which nerve is assessed when the nurse asks the client to spread all fingers?
Ulnar Peroneal Radial Median
The nurse recognizes that rheumatoid arthritis is characterized by:
Ulnar deviation Ballottement sign Clonus Fasciculations
Which is an indicator of neurovascular compromise?
Warm skin temperature Diminished pain Pain upon active stretch Capillary refill of more than 3 seconds
Which is a circulatory indicator of peripheral neurovascular dysfunction?
Weakness Paresthesia Cool skin Paralysis
The nurse is conducting a community education program on hip fracture risk. The nurse evaluates that the participants understand the program when the participants determine that client at highest risk for a hip fracture is a(n)
high school athlete. 30-year-old pregnant woman. toddler just starting to walk. 80-year-old man recently widowed.
What areas of the body may be examined when bone densitometry is done? Select all that apply.
hip spine wrist knee
A client has an exaggerated convex curvature of the thoracic spine. What is this condition called?
kyphosis lordosis scoliosis diaphysis
The nurse is screening children for scoliosis. What nursing assessment finding is indicative of scoliosis?
lateral curvature of the spine loss of 1 inch (2.5 cm) in height contracture of the wrists crepitus of the knee joint
The nurse is assessing a young client during an annual sports physical at school. The assessment reveals that the client has lateral curving of the spine. The nurse reports to the health care professional that the assessment revealed
lordosis. scoliosis. diaphysis. epiphysis.
There are thousands of components of the musculoskeletal system that facilitate mobility and independent function. The function of skeletal muscle is promoting:
movement of skeletal bones. organ function. involuntary function. All options are correct.
Each bone is composed of cells, protein matrix, and mineral deposits. Which type of bone cell works to repair a bone fracture?
osteocytes osteoblasts osteoclasts osteomytes
The nurse is conducting a medication reconciliation with a client admitted with a fracture. What medication predisposes a client for a risk for fractures?
prednisone furosemide digoxin metoprolol
A client reports being consistently tired, with no energy. The client's CBC indicates low hemoglobin. Where is hemoglobin manufactured?
ribs ulna femur eyes
An older adult client has come to the clinic for a regular check-up. The nurse's initial inspection reveals an increased thoracic curvature of the client's spine. The nurse should document the presence of
scoliosis. epiphyses. lordosis. kyphosis.
The human body has 206 bones, which are classified into four categories. Which types of bones are the femur and ulna?
short bones long bones flat bones irregular bones
The nurse is assigned to a client admitted with advanced Parkinson's disease. What type of gait correlates with Parkinson's disease?
shuffling spastic hemiparesis steppage scissors
The nurse is assessing a client's gait. What assessments indicate the client has a normal gait? Select all that apply. spastic hemiparesis
steppage shuffling smoothness knee flexion
A client has recently undergone an invasive joint examination to enable the identification of bone composition. Which signs and symptoms should the nurse monitor in this client?
swelling and bleeding hypersensitivity reaction tingling sensation or numbness nausea and vomiting
A nurse is assessing a child who has a diagnosis of muscular dystrophy. Assessment reveals that the child's muscles have greater-than-normal tone. The nurse should document the presence of which of
tonus. flaccidity. atony. spasticity.
Which data is most important for the nurse to record while assessing a client with an open wound?
when the client last received a tetanus immunization vital signs time and place of the injury degree of movement and range of motion
The older client asks the nurse how best to maintain strong bones. What is the nurse's best response?
"Weight-bearing exercises can strengthen bones." "Range-of-motion exercises build bone mass." "Cardio training is the best way to build bones." "Weight-resistance exercises can strengthen bones."
Which nursing action is most important in caring for the client following an arthrogram?
Apply ice to the joint. Keep the joint below the level of the heart. Administer morphine sulfate. Assist the client with passive range of motion.
A client has had an electromyography. What is an appropriate nursing intervention following this diagnostic procedure?
Apply warm compresses. Apply a compression dressing. Monitor the client for infection. Monitor the client for anaphylaxis.
A client has had a cast placed for the treatment of a humeral fracture. The nurse's most recent assessment shows signs and symptoms of compartment syndrome. What is the nurse's most appropriate action?
Arrange for a STAT assessment of the client's serum calcium levels. Perform active range of motion exercises. Assess the client's joint function symmetrically. Contact the primary provider immediately.
A patient is scheduled for a procedure that will allow the physician to visualize the knee joint in order to diagnose the patient's pain. What procedure will the nurse prepare the patient for?
Arthrocentesis Bone scan Electromyography Arthroscopy
A clinic nurse is caring for a client with a history of osteoporosis. What diagnostic test will best allow the care team to assess the client's risk of fracture?
Arthrography Bone scan Bone densitometry Arthroscopy
A client has been experiencing progressive increases in knee pain and diagnostic imaging reveals a worsening effusion in the synovial capsule. The nurse should anticipate what diagnostic procedure?
Arthrography Knee biopsy Arthrocentesis Electromyography
A client is scheduled to have an x-ray examination of the shoulder in which the synovial fluid will be aspirated and sent to the laboratory for analysis. This will be followed by administration of a contrast medium and x-rays. What procedure will the nurse prepare the client for?
Arthroscopy Arthrocentesis Arthrogram Bone densitometry
The orthopedic nurse is caring for a client diagnosed with a fracture of the radius. When the nurse is considering all of the various types of bone fractures, which bone type is most anticipated?
Collagen Cortical Cancellous Cartilage
The nurse is performing an assessment of a client's musculoskeletal system and is appraising the client's bone integrity. What action should the nurse perform during this phase of assessment?
Compare parts of the body symmetrically. Assess extremities when in motion rather than at rest. Percuss as many joints as are accessible. Administer analgesia 30 to 60 minutes before assessment.
A client has an elbow injury that involves the cartilage in that joint. The nurse understands that which type of cartilage has been affected?
Costal cartilage Semilunar cartilage Fibrous cartilage Hyaline cartilage
Choose the correct statement about the endosteum, a significant component of the skeletal system:
Covers the marrow cavity of long bones Supports the attachment of tendons to bones Contains blood vessels and lymphatics Facilitates bone growth
The homecare nurse is evaluating the musculoskeletal system of a geriatric client whose previous assessment was within normal limits. The nurse initiates a call to the health care provider and/or emergency services when which change is found?
Decreased right-sided muscle strength Decreased flexibility Decreased agility Increased joint stiffness
A client injured in a motor vehicle accident has sustained a fracture to the diaphysis of the right femur. Of what is the diaphysis of the femur mainly constructed?
Epiphyses Cartilage Cortical bone Cancellous bone
A nurse practitioner assesses a patient's movement in his left hand after a cast is removed. The nurse asks the patient to turn his wrist so the palm of his hand is facing up. This movement is known as:
Extension. Pronation. Eversion. Supination.
A client is seen in the emergency room for a knee injury that happened during a basketball game. Diagnostic tests reveal torn cords of fibrous connective tissue that connect muscles to bones. What type of tear has this client sustained?
Fascia Ligament Bursa Tendon
A client's fracture is healing and compact bone is replacing spongy bone around the periphery of the fracture. This process characterizes what phase of the bone healing process?
Hematoma formation Fibrocartilaginous callus formation Remodeling Bony callus formation
A nurse is assessing a client who is experiencing peripheral neurovascular dysfunction. What assessment findings are most consistent with this diagnosis?
Hot skin with a capillary refill of 1 to 2 seconds Absence of feeling, capillary refill of 4 to 5 seconds, and cool skin Pain, diaphoresis, and erythema Jaundiced skin, weakness, and capillary refill of 3 seconds
A nurse understands the influence of hormones on bone maintenance. Therefore, the nurse knows that a patient on long-term cortisol may experience:
Increased deposits of calcium in the bone. Increased bone resorption. Accelerated bone modeling. Inhibition of osteoclasts.
Which assessment finding would cause the nurse to suspect compartment syndrome in the client following a bone biopsy?
Increased diameter of the calf Capillary refill < 3 seconds Toes move freely without pain Bounding dorsalis pedis pulses
The nurse is planning care for a client with a musculoskeletal injury. Which nursing diagnosis would be the highest priority?
Ineffective Health Maintenance Risk for Impaired Tissue Perfusion Acute Pain Delayed Surgical Recovery
After a fracture, during which stage or phase of bone healing is devitalized tissue removed and new bone reorganized into its former structural arrangement?
Inflammation Revascularization Reparative Remodeling
Which of the following is a fibrous sheath that surrounds the articulating bones?
Joint capsule Synovium Ligament Bursa
A client undergoes an invasive joint examination of the knee. What will the nurse closely monitor the client for?
Lack of sleep and appetite Serous drainage Signs of depression Signs of shock
A client experiences a musculoskeletal injury that involves the structure that connects a muscle to the bone. The nurse understands that this injury involves which structure?
Ligament Tendon Cartilage Joint
The nurse is taking care of a client with lower motor neuron destruction. How would the nurse document on the electronic health record the muscle tone in the client's lower legs?
Limp Flaccid Spastic Atonic
A client has sustained traumatic injuries that involve several bone fractures. A fracture of what type of bone may interfere with the protection of the client's vital organs?
Long bones Short bones Flat bones Irregular bones
A nurse's assessment of a teenage girl reveals that her shoulders are not level and that she has one prominent scapula that is accentuated by bending forward. The nurse should expect to read about what health problem in the client's electronic health record?
Lordosis Kyphosis Scoliosis Muscular dystrophy
The client presents with an exaggeration of the lumbar spine curve. How does the nurse interpret this finding?
Lordosis Scoliosis Kyphosis Dowager's hump
A nurse is caring for an older adult who has been diagnosed with geriatric failure to thrive. The nurse should perform interventions to prevent what complication?
Muscle clonus Muscle atrophy Rheumatoid arthritis Muscle fasciculations
The nurse is assessing a client's ulnar nerve. What technique will the nurse use?
Prick the distal fat pad of the small finger. Ask the client to stretch the thumb, then the wrist, then the fingers. Prick the skin mid-way between the thumb and second finger. Ask the client to flex the wrist.
The nurse's musculoskeletal assessment of a client reveals involuntary twitching of muscle groups. How would the nurse document this observation in the client's chart?
Tetany Atony Clonus Fasciculations
A client is scheduled for a bone scan to rule out osteosarcoma of the pelvic bones. What would be most important for the nurse to assess before the client's scan?
That the client completed the bowel cleansing regimen That the client emptied the bladder That the client is not allergic to penicillins That the client has fasted for at least 8 hours
A client's blood test results reveal an elevated alkaline phosphatase. What might this indicate?
a bone tumor Paget's disease osteomalacia systemic lupus erythematosus
A client tells the health care provider about shoulder pain that is present even without any strenuous movement. The health care provider identifies a sac filled with synovial fluid. What condition will the nurse educate the client about?
a fracture of the clavicle osteoarthritis of the shoulder bursitis ankylosing spondylitis
During the interview an older adult client reports joint pain with movement. The client states, "But if I rest it, the pain gets better." What is the most likely cause of client's pain?
Deterioration of the cartilage Relaxation of the ligaments Increase in collagen Decreased muscle mass
The nurse is assessing the client who states a decline in muscle strength. Which is the primary source essential to allow muscle contraction?
Myofibrils Sarcomeres Acetylcholine Actin and myosin
A client is diagnosed with a fracture of a diarthrosis joint. What is an example of this type of joint?
Symphysis pubis Skull Elbow Fifth thoracic vertebrae
The nurse working in the orthopedic surgeon's office is asked to schedule a shoulder arthrography. The nurse determines that the surgeon suspects which finding?
Tear in the joint capsule Fracture of the clavicle Decreased bone density Injury to the radial nerve
After a person experiences a closure of the epiphyses, which statement is true?
The bone grows in length but not thickness. The bone increases in thickness and is remodeled. Both bone length and thickness continue to increase. No further increase in bone length occurs.
A nurse knows that a person with a 3-week-old femur fracture is at the stage where angiogenesis is occurring. What are the characteristics of this stage?
The formation of a hematoma and fibrin. Inflammation and the stimulation of osteoblasts and osteoclasts. Cartilage cells forming matrix villa that regulate calcification of the cartilage. New capillaries producing a bridge between the fractured bones.
Which nursing instruction is most important to stress when teaching on calcium intake?
Eat green, leafy vegetables. Drink calcium- and vitamin D-fortified orange juice. Provide age-related calcium intake recommendations. Maintain diary sources of calcium intake.
A client is scheduled for a bone scan. A bone scan may be ordered to detect metastatic bone lesions, fractures, and certain types of inflammatory disorders. Which nursing considerations are correct in preparing a client for a bone scan? Select all that apply.
Inform the client that the radiopaque isotope will be administered intravenously. Ensure that the client does not have any allergies to the isotope. Encourage the client to drink fluids to help distribute and eliminate the isotope. Ensure the client is NPO for 12 hours before the test.
Which term refers to muscle tension being unchanged with muscle shortening and joint motion?
Isotonic contraction Isometric contraction Contracture Fasciculation
What is the term for a lateral curving of the spine?
Lordosis Scoliosis Diaphysis Epiphysis
During a general musculoskeletal assessment, what would help the nurse determine the client's muscle strength?
Palpating each of the client's muscles and joints. Asking the client to lift specified amounts of weights. Examining extremities for symmetry, size, and contour. Applying force to the client's extremity as the client pushes against that force.
The nurse is assessing the client for scoliosis. What will the nurse have the client do to perform the assessment?
Stand behind the client and ask the client to bend forward at the waist. Stand to the side of the client and observe the client's spinal curvatures. Stand behind the client and ask the client to walk a short distance away. Stand in front of the client and ask the client to bend forward at the waist.
The emergency room nurse is reporting the location of a fracture to the client's primary care physician. When stating the location of the fracture on the long shaft of the femur, the nurse would be most correct to state which terminology locating the fractured site?
The fracture is on the diaphysis. The fracture is ventrally located. The fracture is on the epiphyses. The fracture is on the tuberosity.
A nurse on the orthopedic unit is assessing a client's peroneal nerve. The nurse should perform this assessment by doing what action?
Pricking the skin between the great and second toe Stroking the skin on the sole of the client's foot Pinching the skin between the thumb and index finger Stroking the distal fat pad of the small finger
Which is a neurovascular problem caused by pressure within a muscle area that increases to such an extent that microcirculation diminishes?
Remodeling Hypertrophy Fasciculation Compartment syndrome
After bone fracture, fibrocartilaginous callus formation normally occurs at the same time as which process?
Remodeling Inflammation Fibroblast migration Hematoma formation
A nurse is caring for a client with an undiagnosed bone disease. When instructing on the normal process to maintain bone tissue, which process transforms osteoblasts into mature bone cells?
Remodeling Resorption Ossification and calcification Epiphyses and diaphysis formation
The nurse is admitting an older adult to a skilled nursing facility. What assessment parameters will the nurse expect to find with the musculoskeletal assessment? Select all that apply.
decreased endurance increase in height joint stiffness increased muscle strength decreased range of motion
A bone biopsy has just been completed on a client with suspected bone metastases. The nurse should prioritize assessments for:
dehiscence at the biopsy site. pain. hematoma formation. infection.
The nurse is teaching a client about osteoporosis. What diagnostic test will the nurse include with the client teaching?
dual-energy x-ray absorptiometry bone biopsy arthrocentesis arthroscopy
The nurse is performing a musculoskeletal assessment of a client in a nursing home who had a stroke 2 years ago and who has right-sided hemiplegia. The nurse notes that the girth of the client's right calf is 2 inches less in diameter than the left calf. The nurse attributes the decreased girth to
edema in left lower extremity. increased use of left calf muscle. atrophy of right calf muscle. bruising in right lower extremity.
The nurse working in the emergency department receives a call from the x-ray department communicating that the client the nurse is caring for has a fracture in the shaft of the tibia. The nurse tells the physician that the client's fracture is in the
epiphysis. lordosis. scoliosis. diaphysis.
While assessing a client, the client tells the nurse that she is experiencing rhythmic muscle contractions when the nurse performs passive extension of her wrist. The nurse should recognize the presence of:
fasciculations. contractures. effusion. clonus.
The nurse assesses soft subcutaneous nodules along the line of the tendons in a patient's hand and wrist. What does this finding indicate to the nurse?
The patient has osteoarthritis. The patient has lupus erythematosus. The patient has rheumatoid arthritis. The patient has neurofibromatosis.
The nurse is preparing an education program on risk factors for musculoskeletal disorders. Which risk factors are appropriate for the nurse to include in the teaching program? Select all that apply.
age menopause bed rest calcium-rich diet current cigarette smoking
The nurse is working on an orthopedic floor caring for a client injured in a football game. The nurse is reviewing the client's chart noting that the client has previously had an injured tendon. The nurse anticipates an injury between the periosteum of the bone and which of the following?
Joint Muscle Ligament Cartilage
Which body movement involves moving toward the midline?
Pronation Adduction Abduction Eversion
The nurse is reviewing the client's admission assessment and notes that crepitus of the right knee joint was documented. What assessment will the nurse find as described by crepitus?
a grating sound when a joint is put through range of motion characterized by limited range of motion of a joint excessive fluid within the capsule of a joint characterized by involuntary muscle twitching of the knee
A nurse is providing care for a client whose pattern of laboratory testing reveals long-standing hypocalcemia. What other laboratory result is most consistent with this finding?
An elevated parathyroid hormone level An increased calcitonin level An elevated potassium level A decreased vitamin D level
A client has undergone arthroscopy. After the procedure, the site where the arthroscope was inserted is covered with a bulky dressing. The client's entire leg is also elevated without flexing the knee. What is the appropriate nursing intervention required in caring for a client who has undergone arthroscopy?
Apply a cold pack at the insertion site. Apply warm compresses to the insertion site. Provide a gentle massage. Assist with performing ROM exercises.
A nurse is taking a health history on a client with musculoskeletal dysfunction. What should the nurse prioritize during this phase of the assessment?
Evaluating the effects of the musculoskeletal disorder on the client's function Evaluating the client's adherence to the existing treatment regimen Evaluating the presence of genetic risk factors for further musculoskeletal disorders Evaluating the client's active and passive range of motion
After a bone density test, an older adult female client tells the nurse, "I don't understand why I have osteoporosis because I eat well and take my calcium." What does the nurse explain as the reason that the client may have osteoporosis?
Everyone gets osteoporosis and there is nothing you can do to prevent it. Men lose more bone mass than women but women still lose some. In order to prevent bone loss, women have to take hormones. The loss is from withdrawal of estrogen and a decrease in activity levels.
A nurse is taking a health history on a new client who has been experiencing unexplained paresthesia. What question should guide the nurse's assessment of the client's altered sensations?
How does the strength in the affected extremity compare to the strength in the unaffected extremity? Does the color in the affected extremity match the color in the unaffected extremity? How does the feeling in the affected extremity compare with the feeling in the unaffected extremity? Does the client have a family history of paresthesia or other forms of altered sensation?
A client has been experiencing an unexplained decline in knee function and has consequently been scheduled for arthrography. The nurse should teach the client about what process?
Injection of a contrast agent into the knee joint prior to ROM exercises Aspiration of synovial fluid for serologic testing Injection of corticosteroids into the client's knee joint to facilitate ROM Replacement of the client's synovial fluid with a synthetic substitute
The nurse's comprehensive assessment of an older adult involves the assessment of the client's gait. How should the nurse best perform this assessment?
Instruct the client to walk heel-to-toe for 15 to 20 steps. Instruct the client to walk in a straight line while not looking at the floor. Instruct the client to walk away from the nurse for a short distance and then toward the nurse. Instruct the client to balance on one foot for as long as possible and then walk in a circle around the room.
An instructor is describing the process of bone development. Which of the following would the instructor describe as being responsible for the process of ossification?
Osteoblasts Cortical bone Osteoclasts Cancellous bone
A child is growing at a rate appropriate for his age. What cells are responsible for the secretion of bone matrix that eventually results in bone growth?
Osteoblasts Osteocytes Osteoclasts Lamellae
A patient comes to the clinic and informs the nurse of numbness, tingling, and a burning sensation in the arm from the elbow down to the fingers. What type of symptom would this be documented as?
Paresthesia Flaccidity Atonia Effusion
While reading a client's chart, the nurse notices that the client is documented to have paresthesia. The nurse plans care for a client with
absence of muscle movement suggesting nerve damage. involuntary twitch of muscle fibers. abnormal sensations. absence of muscle tone.
Which medication taken by the client in the previous 24 hours would be of greatest concern to the nurse caring for a client undergoing a bone biopsy?
aspirin furosemide digoxin NPH insulin
The nurse is reading the admission note for a client with a bone fracture that requires surgery. The note indicates the presence of crepitus. The nurse interprets this as being
bleeding. a crackling sound. ecchymosis. a closed fracture.
Fracture healing occurs in four areas, including the
cartilage. external soft tissue. bursae. fascia.
Place an "X" on the figure where the nurse would assess for kyphosis.
x
